Provider Demographics
NPI:1699052902
Name:SUGARMAN, JEFFREY L (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:L
Last Name:SUGARMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 CHARLOTTESVILLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-1147
Mailing Address - Country:US
Mailing Address - Phone:719-573-1177
Mailing Address - Fax:
Practice Address - Street 1:5755 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-1220
Practice Address - Country:US
Practice Address - Phone:719-591-9929
Practice Address - Fax:719-591-5829
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO145361835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14536OtherSTATE OF COLORADO DORA ACTIVE PHARMACIST LICENSE NO.